Tissue expansion: Concepts,techniques and unfavourable results

The phenomenon of tissue expansion is observed in nature all the time. The same properties of the human skin to stretch and expand and yield extra skin if placed under continuous stress over a prolonged period of time has been utilised for reconstructive purposes with the help of a silicon balloon inserted under the skin and progressively filled with saline. The technique of tissue expansion is now more than three decades old and has been a value addition to our armamentarium in reconstructive surgery in all parts of the body. However, it still requires careful patient selection, meticulous planning and faultless execution to successfully carry out the process, which usually lasts for more than 8-12 weeks and involves two sittings of surgery. Any compromise in this process can lead to unfavourable results and complications, some minor, which allow continuance of the process to attain the expected goal and others major, which force abandonment of the process without reaching the expected goal. This article seeks to highlight the intricacies of the concept of tissue expansion, the technique related to flawless execution of the process and likely complications with emphasis on their management. We also present our results from a personal series of 138 patients operated over a period of 18 years between 1994 and 2012.KEY WORDS: Complications, tissue expansion, unfavourable results     

The Relationship Between Verified Organ Donor Designation and Patient Demographic and Medical Characteristics

Previous studies on the correlates of organ donation consent have focused on self‐reported willingness to donate and on self‐reported medical suitability to donate. However, these may be subject to social desirability bias and inaccurate assessments of medical suitability. The authors sought to overcome these limitations by directly verifying donor designation on driver's licenses and by abstracting comorbid conditions from electronic health records. Using a cross‐sectional study design, they reviewed the health records of 2070 randomly selected primary care patients at a large urban safety‐net medical system to obtain demographic and medical characteristics. They also examined driver's licenses that were scanned into electronic health records as part of the patient registration process for donor designation. Overall, 943 (46%) patients were designated as a donor on their driver's license. On multivariate analysis, donor designation was positively associated with age 35–54 years, female sex, nonblack race, speaking English or Spanish, being employed, having private insurance, having an income >$45 000, and having fewer comorbid conditions. These demographic and medical characteristics resulted in patient subgroups with donor designation rates ranging from 21% to 75%. In conclusion, patient characteristics are strongly related to verified donor designation. Further work should tailor organ donation efforts to specific subgroups.     

Interaction between sleep and the immune response in Drosophila: a role for the NFkappaB relish

STUDY OBJECTIVES: The regulation of sleep is poorly understood. While some molecules, including those involved in inflammatory/immune responses, have been implicated in the control of sleep, their role in this process remains unclear. The Drosophila model for sleep provides a powerful system to identify and test the role of sleep-relevant molecules. DESIGN: We conducted an unbiased screen for molecular candidates involved in sleep regulation by analyzing genome-wide changes in gene expression associated with sleep deprivation in Drosophila. To further examine a role of immune-related genes identified in the screen, we performed molecular assays, analysis of sleep behavior in relevant mutant and transgenic flies, and quantitative analysis of the immune response following sleep deprivation. RESULTS: A major class of genes that increased expression with sleep deprivation was that involved in the immune response. We found that immune genes were also upregulated during baseline conditions in the cyc01 sleep mutant. Since the expression of an NFkappaB, Relish, a central player in the inflammatory response, was increased with all manipulations that reduced sleep, we focused on this gene. Flies deficient in, but not lacking, Relish expression exhibited reduced levels of nighttime sleep, supporting a role for Relish in the control of sleep. This mutant phenotype was rescued by expression of a Relish transgene in fat bodies, which are the major site of inflammatory responses in Drosophila. Finally, sleep deprivation also affected the immune response, such that flies deprived of sleep for several hours were more resistant to bacterial infection than those flies not deprived of sleep. CONCLUSION: These results demonstrate a conserved interaction between sleep and the immune system. Genetic manipulation of an immune component alters sleep, and likewise, acute sleep deprivation alters the immune response.     

Quantitation and characterization of glutathionyl haemoglobin as an oxidative stress marker in chronic renal failure by mass spectrometry

OBJECTIVES: Glutathionyl haemoglobin (GS-Hb) belonging to the class of glutathionylated proteins has been investigated as a possible marker of oxidative stress in different chronic diseases. The purpose of this study was to examine whether glutathionyl haemoglobin can serve as an oxidative stress marker in non-diabetic chronic renal failure patients on different renal replacement therapies (RRT) through its quantitation, and characterization of the specific binding site of glutathione in haemoglobin molecule by mass spectrometric analysis. DESIGN AND METHODS: The study group consisted of non-diabetic chronic renal failure patients on renal replacement therapy (RRT): hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD) and renal allograft transplant (Txp) patients. Haemoglobin samples of these subjects were analyzed by liquid chromatography electrospray ionization mass spectrometry for GS-Hb quantitation. Characterization of GS-Hb was done by tandem mass spectrometry. Levels of erythrocyte glutathione (GSH) and lipid peroxidation (as thiobarbituric acid reacting substances) were measured spectrophotometrically, while glycated haemoglobin (HbA1c) was measured by HPLC. RESULTS: GS-Hb levels were markedly elevated in the dialysis group and marginally in the transplant group as compared to the controls. GS-Hb levels correlated positively with lipid peroxidation and negatively with the erythrocyte glutathione levels in RRT groups indicating enhanced oxidative stress. De novo sequencing of the chymotryptic fragment of GS-Hb established that glutathione is attached to Cys-93 of the beta globin chain. Mass spectrometric quantitation of total glycated haemoglobin showed good agreement with HbA1c estimation by conventional HPLC method. CONCLUSIONS: Glutathionyl haemoglobin can serve as a clinical marker of oxidative stress in chronic debilitating therapies like RRT. Mass spectrometry provides a reliable analytical tool for quantitation and residue level characterization of different post-translational modifications of haemoglobin.     

Predicting PSA response of prostate cancer to radiation therapy with Doppler sonography

OBJECTIVE: We report a prospective investigation of the correlation between pretreatment Doppler vascular density (DVD) of the entire prostate gland and subsequent prostate-specific antigen (PSA) response following external beam radiation therapy, for patients with low- or intermediate-risk prostate cancer. This report updates a previous report (Sehgal et al., Acad Radiol 2003;10:366) with longer patient follow-up and additional quantitative and clinically relevant end points. METHODS: Before radiation therapy, we imaged 12 patients with transrectal Doppler sonography and measured the mean DVD of the prostate for each. For analysis, patients were separated into 3 groups by low, intermediate, and high DVD. The mean DVD for each group was linearly correlated with mean values for time above a PSA threshold of 1.0 ng/ml, post-therapy plateau PSA, and nadir PSA. RESULTS: We previously observed that pretreatment mean DVD had a strong inverse correlation with initial rate of post-therapy decline in PSA. With substantially longer follow-up on the same cohort of patients (median, 52 months), we now observe that pretreatment mean DVD also correlates with post-therapy nadir PSA (R = 0.94) and with time above a PSA threshold of 1.0 ng/mL (R = 0.99). CONCLUSION: The results of the current study are consistent with our earlier suggestion that pretreatment measurement of DVD of the entire prostate gland may be a clinically useful prognostic indicator in early prostate cancer treated with radiation. However, additional data from larger numbers of patients are needed to draw firm conclusions.